MEDICARE: MS. SUSAN MICHELLE VAN ARSDEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1235554023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN MICHELLE VAN ARSDEL

Provider Business Mailing Address
First Line	:	2910 SAINT MARYS AVE STE 1
Second Line	:
City	:	HANNIBAL
State	:	MO
Zip	:	63401-3727
Country	:	US
Telephone Number	:	573-221-2273
Fax Number	:	573-221-1720

Provider Business Practice Location Address
First Line	:	2910 SAINT MARYS AVE STE 1
Second Line	:
City	:	HANNIBAL
State	:	MO
Zip	:	63401-3727
Country	:	US
Telephone Number	:	573-221-2273
Fax Number	:	573-221-1720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2014
Last Update Date	:	03/03/2014

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